Please provide the following contact information:

Name		Age
Address
City
State		Zip/Postal Code
BirthDay
School
Club Team:
Telephone
E-mail
Father's Name
Work Phone
Mother's Name
Work Phone

Please identify and describe yourself:

Sex	Male Female
Height
Weight

First Session: June 17 - 21

Second Session: June 24 - 28

Third Session: July 01, 02, 03, & 05

Fourth Session: Not scheduled

Time: 9:00am - 3:00pm

Fee of $350.00 1st, 2nd & 4th Sessions, $300.00 3rd Session Required.

In case of a medical emergency, if I cannot be contacted, I give permission for my child to receive emergency medical treatment. I wave and release The First Class Elite Soccer Camp, MCPS Staff and Officials from all liability to injuries and illness suffered while at camp.

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